Mimicking focal epileptic seizures-episodic pain due to a facial foreign body in a puppy: Imaging characteristics and treatment

A 4-month-old female entire Cavalier King Charles Spaniel was referred for investigation into a 3-week history of suspected focal onset seizures, characterised by head nodding and eyelid twitching. An inflammatory soft-tissue reaction surrounding a suspected foreign body (FB) in the subcutaneous tissue and muscles at the level of the left maxilla in the caudal aspect of the left maxillary second molar was detected using MRI. The presence of the FB was confirmed ultrasonographically. This was found to be a grass seed upon surgical removal. The previously reported clinical signs resolved immediately after the surgery. It was suspected that the FB and secondary inflammatory reaction incited a form of trigeminal neuralgia manifesting as paroxysmal head nodding and facial twitching. A form of trigeminal neuralgia should be included in the differential diagnosis of facial focal motor seizures and should be investigated accordingly before initiating any antiepileptic treatment.